Healthcare Provider Details

I. General information

NPI: 1386620466
Provider Name (Legal Business Name): HENRY R LESIEUR PSYD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST APC 970
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

593 EDDY ST APC 970
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 401-277-0700
  • Fax: 401-277-0744
Mailing address:
  • Phone: 401-277-0700
  • Fax: 401-277-0744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPS00787
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS00787
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: